Demographics - DH Application

This survey is supplemental information to the DH Application. The information submitted is confidential, and will not be considered as criteria for acceptance. However, we ask that all DH applicants complete this full survey as is used for program funding and mandatory accreditation reporting.

There are eight (8) required questions in this survey. Please complete this survey completely and to the best of your ability.

* Required

Last Name
*

This is a required question

First Name
*

This is a required question

Middle Name
*

If no middle name enter "none"

This is a required question

Cabrillo College Student ID number
*

Please enter your Student ID number below

This is a required question

Have you previously applied to the Cabrillo College Dental Hygiene Program?
*

Select Yes or No. If yes, please answer the next question. If no, skip to the following question.

Yes, I have applied to the Cabrillo College Dental Hygiene Program

No, I have never applied to the Cabrillo College Dental Hygiene Program

This is a required question

What were the approximate dates you applied ?

If you answered Yes to the above question, please answer this question. If No, skip to the next question.

This is a required question

Have you previously attended any other dental hygiene program(s)?
*

If Yes, please name the programs. If No, skip to the next question.

This is a required question

Briefly describe the reason(s) you left the above program(s) in the space provided below.

This is a required question

Select the range that indicates the recency of your science prerequisites. Recency is the amount of time since you have taken prerequisites.
*

Select the range that best fits from the list below. Please note, Cabrillo College and the DH Program does not have a recency policy and this does not currently affect application to the program.